Formula One With Ms Lecture

Mr. Anecito O. Pol jr

A311/level3 Bsn

Burn injuries result in both local and systemic responses. Local response The three zones of a burn were described by Jackson in 1947.

Zone of coagulation—This occurs at the point of maximum damage. In this zone there is irreversible tissue loss due to coagulation of the constituent proteins. Zone of stasis—The surrounding zone of stasis is characterised by decreased tissue perfusion. The tissue in this zone is potentially salvageable. The main aim of burns resuscitation is to increase tissue perfusion here and prevent any damage becoming irreversible. Additional insults —such as prolonged hypotension, infection, or oedema—can convert this zone into an area of complete tissue loss. Zone of hyperaemia—In this outermost zone tissue perfusion is increased. The tissue here will invariably recover unless there is severe sepsis or prolonged hypoperfusion. These three zones of a burn are three dimensional, and loss of tissue in the zone of stasis will lead to the wound deepening as well as widening. Systemic response The release of cytokines and other inflammatory mediators at the site of injury has a systemic effect once the burn reaches 30% of total body surface area. Cardiovascular changes—Capillary permeability is increased, leading to loss of intravascular proteins and fluids into the interstitial compartment. Peripheral and splanchnic vasoconstriction occurs. Myocardial contractility is decreased, possibly due to release of tumour necrosis factor . These changes, coupled with fluid loss from the burn wound, result in systemic hypotension and end organ hypoperfusion. Respiratory changes—Inflammatory mediators cause bronchoconstriction, and in severe burns adult respiratory distress syndrome can occur. Metabolic changes—The basal metabolic rate increases up to three times its original rate. This, coupled with splanchnic hypoperfusion, necessitates early and aggressive enteral feeding to decrease catabolism and maintain gut integrity. Immunological changes—Non-specific down regulation of the immune response occurs, affecting both cell mediated and humoral pathways. Renal injuries are caused by damage and destruction of renal tubules. This may occur due to a variety of different mechanisms, ultimately all lead to hypoxia and ischemia: 1. Medullary ischemia – due to hypoxic injury to the thick limb of the loop of

Henle. This leads to reduction in tubular filtration, via feedback mechanisms.

2. Tubular obstruction – due to casts, which are damaged tubular cells.

The tubular pressure builds up and glomerular filtration is inhibited.

3. Interstitial edema: tubular fluid leaks in between damaged cells. 4. Vasoconstriction: due to release of vasoactive agents in critical illness.

Tubular obstruction, with backflow of tubular fluid causing oliguria

It is thought that the mechanism behind oliguria is ischemic injury to tubular cells which subsequently slough off as casts and block the passage of fluid through the nephron. Pressure builds up in the pre-obstruction area, and is reflected backwards towards the Bowman’s Capsule. As the pressure increases, less and less is filtered, and oliguria becomes pathological. When the pressure in the Capsule equals the net filtration pressure, filtration stops and the patient becomes anuric. One of the reasons why some experts recommend the use of diuretics is to flush debris out of the nephrons, and allow filtration and passage of urine. The efficacy of this technique has not been established. What is FOURmula ONE for Health? Defining the Road Map for Reforms FOURmula ONE for Health is the implementation framework for health sector reforms in the Philippines for the medium term covering 2005-2010. It is designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements. This document provides the road map towards achieving the strategic health sector reform goals and objectives of FOURmula ONE for Health from the national down to the local levels.

FOURmula ONE for Health engages the entire health sector, including the public and private sectors, national agencies and local government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a brighter future for generations to come. Starting the Race with the End in Mind: Fourmula One for Health Goals and Objectives Over-all Goals: The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine Development Plan: * Better health outcomes; * More responsive health system; and * More equitable healthcare financing. General Objective: FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor. Specific Objectives: Fourmula One for Health will strive, within the medium term, to: * Secure more, better and sustained financing for health; * Assure the quality and affordability of health goods and services; * Ensure access to and availability of essential and basic health packages; and * Improve performance of the health system